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3,531 questions
A 22-year-old student is admitted by ambulance from a local night club. He has no previous medical history of note and is adopted so is unaware of his family history. Bystanders who have accompanied him say that he suffered sudden collapse while dancing. Bouncers at the club claim that they couldn't feel a strong pulse during his period of unconsciousness. On admission his blood pressure is 120/60 mmHg, and pulse is 80 bpm and regular. ECG looks normal, corrected QT interval is 0.6 s. What diagnosis fits best with his clinical picture?
A 26-year-old woman attends her GP for an insurance medical. Her previous medical history is unremarkable. On examination her BMI is 21, blood pressure is 105/62 mmHg, and USMLE IM2e/Diagnostic auscultation of the heart reveals a late systolic click, and a late diastolic murmur (these findings being accentuated in the stand.ing position). What diagnosis fits best with this clinical picture?
A 72-year-old man presented with an episode of collapse. He had experienced two similar episodes recently, each lasting about one minute. Four years previously he suffered an anterior myocardial infarction. On examination he was orientated and symptom-free with a regular pulse rate of 80 beats per minute (bpm), blood pressure 140/80 mmHg, and the apex beat was displaced to the left. There was an apical systolic murmur. There were no signs of trauma. The electrocardiogram (ECG) showed sinus rhythm, Q waves, and ST segment elevation anteriorly without reciprocal depression. What is the diagnosis?
You are asked to review a 19-year-old woman who presents with increasing shortness of breath on exercise. She is from a travelling family and has rarely encountered medical care. On examination she appears of short stature with extra skin folds around her neck, and appears to have failure of secondary sexual development. Her blood pressure is raised at 165/100 mmHg. She reports that her legs feel tired all the time and she has occasional chest pain on exercising. Which of the following cardiac diagnoses fits best with her clinical condition?
A 45-year-old man attends for review. He has been suffering increasing shortness of breath over the past few years. He is a non-smoker who drinks 20 units per week of alcohol and has no significant past cardiovascular history. Now he presents with what seems to have been a transient ischaemic attack (TIA), with weakness and co-ordination problems affecting his left side, which have resolved over the past 24 hours. On examination blood pressure is 142/95 mmHg and he is in sinus rhythm. There is no opening snap, but a diastolic murmur is heard which changes in character according to posture. Bloods are unremarkable, including C-reactive protein (CRP), which is in the normal range. Which of the foilowing diagnoses fit best with this clinical picture?
A 78-year-old lady is admitted from home by ambulance. She was found lying on the floor by her home help after suffering a fall. She has a history of hypertension managed with ramipril 10mg PO daily. On examination her temperature is 30.0oC, her BP is 100/50 mm.Hg, with a pulse of 52/min. She has a fractured left neck of femur. Bloods; Hb 14.5 g/dl, WCC 4.5 x109/l, PLT 192 x109/l, Na+ 143 mmol/1, K+ 5.3 mmol/l, ereatinine 195 µmol/1. Which of the following ECG features is most characteristic of moderate to severe hypothermia?
A 19-year-old female university student presents with problems in both arms and difficulty walking. Since starting her course she has bad difficulty writing, typing, and other such activities, and thus has struggled to keep up with the workload. She says the arms have ''felt unusual'' for around 6 months. She describes finding small burns and blisters on her arms that she can't remember getting in the first place. In the last few weeks she has also fallen twice when walking up the stairs. The only other thing she describes is some mild occipital headaches that have increased in frequency lately. She is otherwise fit and well. On examination, there is a loss of pinprick sensation found throughout the arms and on the back to around T3 level. Her hands appear to have some element of small muscle wasting and there is some loss of power throughout the arms. Reflexes are hard to elicit or possibly absent. In the legs, there is some mild symmetrical weakness, and the knee reflexes appear brisk. Plaotars appear equivocal. What is the most likely diagnosis?
A 23-year-old woman presents to the GP complaining of palpitations. She says these are rapid and when she gets them she feels light headed and sick. They tend to come on without warning, but have occurred when she bas been out dancing with friends, and after a game of squash. On examination she looks well; her BMI is 21, pulse 70/min regular, BP 122/70 mmHg. Bloods; Hb 13.1 g/dl, wee5.4 x109/l, PLT 251 x109/l, Na+ 139 mmol/1, K+ 4.0 mmol/1, ereatinine 75 µmol/1. Which of the following investigations is most likely to help with the diagnosis?
A 19-year-old man is recently diagnosed with type 1 diabetes and attends your clinic to ask about possible complications in the future. He mentions an 11ncle who has end-stage renal disease due to poorly controlled diabetes and specifically enquires about testing for early signs of renal impairment. The most appropriate investigation is:
A 56-year old man has a myocardial infarction the day after a hernia repair. You request an ECG and then compare it to his pre-admission trace. You notice ST-segment changes in leads II, ID and aVF. In which part of the myocardium is the infarct?
A 30-year-old man is being investigated for hypertension. A combination of BPs estimated by colour flow Doppler and measured values are listed below. Observed BPs: LV 200/10 mmHg, Ascending aorta 200/70 mm.Hg, Right arm 190/70 mmHg, Right femoral artery 110/70 mmHg. Which of the following is the most likely diagnosis?
K+ 5.0 mmol/1, Creatinine 100 µmol/1. ECG LVH and widespread Q waves. Which of the following is most directly correlated with increased risk of sudden death?
A 60-year-old woman presents to her GP with a chronic cough associated with thick, yellow sputum for the past year. Sometimes, the sputum is blood-tinged. She had been prescribed multiple courses of antibiotics but they did not seem to help. She had a past medical history of severe pneumonia that required admission to the intensive care unit for 20 days. On chest examination, there are inspiratory crackles throughout the lung fields, with normal vesicular breath sounds. Which of the following is the most likely differential diagnosis?
A 42-year-old man with the features of congenital myotonic dystrophy comes to see you for review. He has suffered from mild intellectual impairment, frontal balding typical of the disease and increasing muscle weakness with increased muscle tone over the past few years. Most recently he has suffered from a number of episodes of syncope. On examination his BP is 129/70 mmHg, his pulse 55 BPM, there are no other significant findings on cardiovascular examination. What ECG findings might you most commonly expect to see in this case?
A 67-year-old man attends the cardiology clinic. He bas been suffering some angina-type chest pain on going out in the cold air and is worried that he might have coronary artery disease. There is a past medical history of smoking 20 cigarettes per day, and hypertension which is managed with ramipril 10mg daily. His GP has sent an ECG which appears to show that he is in left bundle branch block. What would you expect to hear on auscultation?
A 70-year-old man presents with severe tearing back and chest pain which came on very suddenly. He has a past medical history of hypertension for which he takes ramipril 10mg daily, amlodipine 5mg, and he smokes 30 cigarettes per day. On examination he is in severe pain, his BP is 155/85 mmHg, he has bilateral upgoing plantars and 4/5 weakness affecting left ankle dorsiflexion. He appears to have a pericardia! rub. Which of the following features is most suggestive of dissecting aortic aneurysm?
A 72-year-old man was admitted with an acute anterior myocardial infarction. He bas chronic renal impairment, with a recent creatininerecorded at 148 µmol/1. Medication included ramipril, atorvastatin and indapamide for the treatment of hypertension. He was taken straight to the angiography suite where he received stenting of a left main stem stenosis. You are asked to see him about 30hrs after as the nurses feel he is deteriorating. On examination his BP is 149/84 mmHg, his pulse is 75/min and regular. His legs look dusky in colour, particularly his right big toe which looks blue in colour. He has splinter haemorrhages affecting toenails on both feet. There is a loud left femoral bruit. Investigations; Hb 13.2 g/dl, WCC 5.0 x109/l, PLT 190 x109/l, Na+ 141 mmol/1, K+ 5.9 mmol/1, Creatinine 630 µmol/1, Urine blood++, protein+. Which of the following is the most likely diagnosis?
A 21-year-old woman presents to the clinic with symptoms of increased shortness of breath and decreased exercise tolerance. She used to be a keen hockey player when at school but is now virtually unable to even walk to the bus stop without becoming short of breath. On examination she looks tired and slightly short of breath at rest. Her BP is elevated at 145/92 mmHg. Investigations; Echocardiogram -increased right atrial size, elevated right arterial pressure by Doppler Cardiac catheterization; 02 saturation SVC 74o/o, 02 saturation RA 82o/o, 02 saturation RV 82o/o , 02<w:t>saturation LA 91o/o , 02<w:t>saturation LV 91% . Which of the following is the most likely diagnosis?
A 54-year-old man with a history of smoking and hypertension presents to the Emergency room with central crushing chest pain, nausea and sweating. On examination his BP is 104/70 mmHg, his pulse 85/min regular and he looks pale, grey and sweaty. There are no murmurs on auscultation but he has crackles at both lung bases consistent with heart failure. Investigations; Hb 12.8 g/dl, WCC 5.9 x109/l, PLT 190 x109/l, Na+ 141 mmol/1, K+ 5.0 mmol/1, Creatinine 110 µmol/1, ECG ST elevation Vl-V4, ST depression II, III and aVL. Which of the following is the most likely finding on angiography?
A 32-year-old woman presents to her GP complaining of tingling and numbness around her mouth for 1 week. Occasionally, she also develops painful carpal spasm. She has a past medical history of Graves disease for which she just recently had subtotal thyroidectomy. What is the most likely diagnosis?